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© Continuing Medical Implementation …...bridging the care gap Fundoscopic Examination Window to the blood vessels
© Continuing Medical Implementation …...bridging the care gap http://medicine.osu.edu/exam/
© Continuing Medical Implementation …...bridging the care gap Optic disc Optic cup Vein Arterioles Fovea Normal Ocular Fundus
© Continuing Medical Implementation …...bridging the care gap Fundoscopic Examination Hypertensive retinopathy Diabetic retinopathy Bacterial endocarditis Athero-emboli Cholesterol emboli
© Continuing Medical Implementation …...bridging the care gap Hypertensive Retinopathy Modified Scheie Classification Grade 0: No changes Grade 1: Minimal arteriolar narrowing Grade 2: Obvious arteriolar narrowing with focal irregularities Grade 3: Grade 2 + retinal hemorrhages and/or exudate Grade 4: Grade 3 + swollen optic nerve (Malignant hypertension)
© Continuing Medical Implementation …...bridging the care gap Hypertensive Retinopathy Grade 2 Arteriovenous nicking in association with hypertension Grade 2 (yellow arrow)
© Continuing Medical Implementation …...bridging the care gap Hypertensive Retinopathy Grade 3 Flame-shaped hemmorhage in association with severe hypertension Grade 3 (yellow arrow)
© Continuing Medical Implementation …...bridging the care gap Hypertensive Retinopathy Grade 4 Papilledema from malignant hypertension. There is blurring of the borders of the optic disk with hemorrhages (yellow arrows) and exudates (white arrow)
© Continuing Medical Implementation …...bridging the care gap Current Perspectives of Diabetic Retinopathy A Photo-Essay for Health Professionals- Current Perspectives of Diabetic Retinopathy A Photo-Essay for Health Professionals- John G. O'Shea MD, Robert B. Harvey FRCSE http://medweb.bham.ac.uk/easdec/eye textbook/dminternet.htm
© Continuing Medical Implementation …...bridging the care gap A Classification of Diabetic Retinopathy Non-proliferative diabetic retinopathy (NPDR) Mild non-proliferative diabetic retinopathy –Microaneurysms –Dot and blot haemorrhages –Hard ( intra-retinal ) exudates Moderate-to-severe non- proliferative diabetic retinopathy –The above lesions, usually with exacerbation, plus: –Cotton-wool spots –Venous beading and loops –Intra-retinal microvascular abnormalities ( IRMA ) Proliferative diabetic retinopathy –Neovascularization of the retina, optic disc or iris –Fibrous tissue adherent to vitreous face of retina –Retinal detachment –Vitreous haemorrhage –Pre retinal haemorrhage Maculopathy –Clinically significant macular oedema (CSME ) –Ischaemic Maculopathy
© Continuing Medical Implementation …...bridging the care gap Perifoveal microaneuryisms and haemorrhages Retinal microaneurysms are focal dilatations of retinal capillaries, 10 to 100 microns in diameter, and appear as red dots. They are usually seen at the posterior pole, especially temporal to the fovea. They may apparently disappear whilst new lesions appear at the edge of areas of widening capillary non-perfusion.
© Continuing Medical Implementation …...bridging the care gap Cotton Wool Spots Cotton wool spots result from occlusion of retinal pre-capillary arterioles supplying the nerve fibre layer with concomitant swelling of local nerve fibre axons. Also called "soft exudates" or "nerve fibre layer infarctions" they are white, fluffy lesions in the nerve fibre layer.
© Continuing Medical Implementation …...bridging the care gap Hard exudates (Intra-retinal lipid exudates) Hard exudates ( Intra-retinal lipid exudates ) are yellow deposits of lipid and protein within the sensory retina. Accumulations of lipids leak from surrounding capillaries and microaneuryisms, they may form a circinate pattern. Hyperlipidaemia may correlate with the development of hard exudates.
© Continuing Medical Implementation …...bridging the care gap Bacterial Endocarditis: Roth Spots Roth spot. The yellow arrow indicates a hemmorhage with a white central spot typical of subacute bacterial endocarditis
© Continuing Medical Implementation …...bridging the care gap Pseudoxanthoma elasticum Blue sclera Angioid streaks Coronary artery calcification Systemic hypertension Intermittent claudication Arrhythmias
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